Hydrocephalus after decompressive craniectomy for hemispheric cerebral infarction.

The aim of the present study was to investigate the risk factors for hydrocephalus after decompressive craniectomy (DC) for hemispheric cerebral infarction. This study selected 28 patients who underwent DC for malignant hemispheric cerebral infarction. The patients' clinical and radiologic findings were retrospectively reviewed. Fourteen of the 28 patients were male and 14 were female, with an age range from 34 to 80 years (mean, 63.5 years). Eighteen patients (64.3%) underwent DC within 48 hours of stroke onset. The superior limit of DC was <25 mm from the midline in 16 patients (57.1%). Twenty-two patients underwent cranioplasty, and the interval from DC to cranioplasty was within 60 days in 14 patients. Pre- and post-cranioplasty hydrocephalus were observed in 13 and nine patients, respectively. Two patients required shunt procedures for post-cranioplasty hydrocephalus. Patients with DC whose superior limit was <25 mm from the midline had a significantly increased risk of developing not only pre-cranioplasty but also post-cranioplasty hydrocephalus (p=0.008, p=0.010, respectively). In addition, the presence of pre-cranioplasty hydrocephalus was significantly associated with the development of post-cranioplasty hydrocephalus (p=0.001). The presence of pre- and post-cranioplasty hydrocephalus was significantly associated with a poor outcome (p=0.031, p=0.049, respectively). DC with a superior limit <25 mm from the midline should be avoided to prevent the development of hydrocephalus.